Program for Evaluating Payment
Patterns Electronic Report

Provide your feedback on PEPPER.

National-level Data Reports

Critical Access Hospitals

National Target Area Analysis – Critical Access Hospitals (47kbs PDF, updated 04-23-2014)
The link below provides national-level statistics for areas identified as at-risk for improper payments in critical access hospitals. The data include the number of Medicare discharges for the numerator and denominator for each target area, proportion for each target area, average Medicare payment for a claim in each target area and the sum of total Medicare payments for each target area for all hospitals in the nation. For more information on the areas identified as at risk for improper payments, please see the Critical Access Hospital PEPPER User’s guide.

 

National Top 20 DRGs for Critical Access Hospital (31kbs PDF, updated 04-23-2014)
A listing of the top 20 DRGs by volume of Medicare discharges for all critical access hospitals in the nation. The data are aggregated at the national level. The data include the number of discharges, proportion of discharges for the DRG to total discharges and national average length of stay for each DRG. The data represent the most recent four quarters of discharges. 

 

State Target Area Analysis – Critical Access Hospitals (445kbs Excel, updated 04-23-2014)
The link below provides state-level statistics for areas identified as at-risk for improper payments in critical access hospitals. The data include the number of Medicare discharges for the numerator and denominator for each target area, proportion for each target area, average Medicare payment for a claim in each target area and the sum of total Medicare payments for each target area for all hospitals in each state with three or more CAHs. This file is a Microsoft Excel workbook; click on the worksheet tabs to obtain the report for each state. Target area statistics are reported when there are at least three hospitals with 11 target area discharges. For more information on the areas identified as at risk for improper payments, please see the Critical Access Hospital PEPPER User’s guide..

 

State Top DRGs for Critical Access Hospital (243kbs Excel, updated 04-23-2014)
A listing of the top DRGs (up to 20) by volume of Medicare discharges for all critical access hospitals in each state with three or more CAHs. The data are aggregated at the state level. The data include the number of discharges, proportion of discharges for the DRG to total discharges and average length of stay for each DRG. The data represent the most recent four quarters of discharges. This file is a Microsoft Excel workbook; click on the worksheet tabs to obtain the report for each state. DRGs are included in the report if there are at least 11 discharges for the DRG in the most recent four quarters.

 

Short-term Acute Care Hospitals

Target Area Analysis – Short-term Acute Care Hospitals (460kbs XLS, updated 5-21-2014)
The link below provides national-level statistics for areas identified as at-risk for improper payments in short-term acute care hospitals. The data include the number of Medicare discharges for the numerator and denominator for each target area, proportion for each target area, average Medicare payment for a claim in each target area and the sum of total Medicare payments for each target area for all hospitals in the nation. For more information on the areas identified as at risk for improper payments, please see the Short-term PEPPER User’s Guide (819kbs PDF).

 

Top 20 Medical DRGs for Same- and One-day Stays for Short-term Acute Care Hospitals (29kbs XLS, updated 5-21-2014)
A listing of the top 20 DRGs by volume of Medicare discharges for medical DRG same- and one-day stays for all short-term acute care PPS hospitals in the nation. The data are aggregated at the national level. A same-day stay occurs when a patient is admitted as an inpatient and discharged on the same day; a one-day stay occurs when a patient is admitted as an inpatient on one day and discharged on the following day. When the patient dies, leaves against medical advice or is transferred to another short-term acute care PPS hospital (patient status codes 20, 07 02 or 82), these claims are not included in the data. These data represent the most recent four quarters of Medicare discharges.

 

Top 20 Surgical DRGs for Same- and One-day Stays for Short-term Acute Care Hospitals (29kbs XLS, updated 5-21-2014)
A listing of the top 20 surgical DRGs by volume of Medicare discharges for same- and one-day stays for all short-term acute care PPS hospitals in the nation. The data are aggregated at the national level. A same-day stay occurs when a patient is admitted as an inpatient and discharged on the same day; a one-day stay occurs when a patient is admitted as an inpatient on one day and discharged on the following day. When the patient dies, leaves against medical advice or is transferred to another short-term acute care PPS hospital (patient status codes 20, 07, 02 or 82), these claims are not included in the data. These data represent the most recent four quarters of Medicare discharges.

 

National Payment Error Data FY 2007 (141kbs Excel)
Improper payment error data, including projected national payment error statistics and improper payments by DRG. The data presented here may not match estimates presented in the "Improper Medicare Fee for Service Payments Report" as the data represent only short-term, acute-care inpatient claims, the reporting time frame may be different, and the method of calculating the error rate may slightly differ.

 

Long-term Acute Care Hospitals

Target Area Analysis – Long-term Acute Care Hospitals (35kbs PDF, updated 04-17-2014)
The link below provides national-level statistics for areas identified as at-risk for improper payments in long-term acute care hospitals. The data include the number of Medicare discharges for the numerator and denominator for each target area, proportion for each target area, average Medicare payment for a claim in each target area and the sum of total Medicare payments for each target area for all hospitals in the nation. For more information on the areas identified as at risk for improper payments, please see the Long-term PEPPER User’s Guide (324kbs PDF).

 

Top 20 DRGs for Long-term Acute Care Hospitals (32kbs PDF, updated 04-17-2014)
A listing of the top 20 DRGs by volume of Medicare discharges for all long-term acute care PPS hospitals in the nation. The data are aggregated at the national level. The data include the number of Medicare discharges, average length of stay and number and percentage of discharges that are short-stay outliers for each DRG. The data represent the most recent four quarters of discharges.

 

Inpatient Psychiatric Facilities

National Target Area Analysis – All IPFs (29kbs PDF, updated 04-23-2014)
The link above provides national-level statistics for areas identified as potentially at risk for improper payments in IPFs. The data include the number of Medicare discharges for the numerator and denominator for each target area, proportion for each target area, average Medicare payment for a claim in each target area and the sum of total Medicare payments for each target area for all IPFs in the nation. For more information on the areas identified as potentially at risk for improper payments, please see the IPF PEPPER User’s Guide.

 

National Target Area Analysis – Free-standing IPFs (33kbs PDF, updated 04-23-2014)
The link above provides national-level statistics for free-standing IPFs for areas identified as potentially at risk for improper payments in IPFs. The data include the number of Medicare discharges for the numerator and denominator for each target area, proportion for each target area, average Medicare payment for a claim in each target area and the sum of total Medicare payments for each target area for all free-standing IPFs in the nation. For more information on the areas identified as potentially at risk for improper payments, please see the IPF PEPPER User’s Guide

 

National Target Area Analysis – IPF Distinct Part Units of Short-term Acute Care Hospitals (33kbs PDF, updated 04-23-2014)
The link below provides national-level statistics for IPF distinct part units of short-term acute care hospitals for areas identified as potentially at risk for improper payments in IPFs. The data include the number of Medicare discharges for the numerator and denominator for each target area, proportion for each target area, average Medicare payment for a claim in each target area and the sum of total Medicare payments for each target area for all IPF distinct part units of short-term acute care hospitals in the nation. For more information on the areas identified as potentially at risk for improper payments, please see the IPF PEPPER User’s Guide.

 

National Top 20 DRGs for  All IPFs (30kbs PDF, updated 04-23-2014)
A listing of the top 20 DRGs by volume of Medicare discharges for all IPFs in the nation. The data are aggregated at the national level and include the number of discharges, proportion of discharges for the DRG to total discharges and national average length of stay for each DRG. The data represent the most recent four quarters of discharges through Q4FY13 (October 1, 2012 – September 30, 2013). 
 

 

National Top 20 DRGs for Free-standing IPFs (30kbs PDF, updated 04-23-2014)
A listing of the top 20 DRGs by volume of Medicare discharges for all free-standing IPFs in the nation. The data are aggregated at the national level and include the number of discharges, proportion of discharges for the DRG to total discharges and national average length of stay for free-standing IPFs for each DRG. The data represent the most recent four quarters of discharges through Q4FY13 (October 1, 2012 – September 30, 2013).

 

National Top 20 DRGs for IPF Distinct Part Units of Short-term Acute Care Hospitals (30kbs PDF, updated 04-23-2014)
A listing of the top 20 DRGs by volume of Medicare discharges for all IPF distinct part units of short-term acute care hospitals in the nation. The data are aggregated at the national level and include the number of discharges, proportion of discharges for the DRG to total discharges and national average length of stay for IPF distinct part units for each DRG. The data represent the most recent four quarters of discharges through Q4FY13 (October 1, 2012 – September 30, 2013).  
 

 

IPF Target Percent Boundaries for Free-standing IPFs and IPF Distinct Part Units of Short-term Acute Care Hospitals (96kbs PDF, updated 04-23-2014)
Graphs displaying, for each of the areas identified as potentially at risk for improper Medicare payments, the target area percents that are at the 80th, 50th and 20th percentiles for free-standing IPFs and for IPF distinct part units of short-term acute care hospitals for the most recent four quarters ending Q4FY13 (October 1, 2012 – September 30, 2013). For more information on the areas identified as potentially at risk for improper payments, please see the IPF PEPPER User’s Guide.

 

Inpatient Rehabilitation Facilities

National Target Area Analysis – All IRFs (27kbs PDF, updated 04-17-2014)
The link above provides national-level statistics for areas identified as potentially at risk for improper payments in IRFs. The data include the number of Medicare discharges for the numerator and denominator for each target area, proportion for each target area, average Medicare payment for a claim in each target area and the sum of total Medicare payments for each target area for all IRFs in the nation. For more information on the areas identified as potentially at risk for improper payments, please see the IRF PEPPER User’s Guide.

 

National Target Area Analysis – Free-standing IRFs (26kbs PDF, updated 04-17-2014)
The link above provides national-level statistics for free-standing IRFs for areas identified as potentially at risk for improper payments in IRFs. The data include the number of Medicare discharges for the numerator and denominator for each target area, proportion for each target area, average Medicare payment for a claim in each target area and the sum of total Medicare payments for each target area for all free-standing IRFs in the nation. For more information on the areas identified as potentially at risk for improper payments, please see the IRF PEPPER User’s Guide

 

National Target Area Analysis – IRF Distinct Part Units of Short-term Acute Care Hospital (26kbs PDF, updated 04-17-2014)
The link below provides national-level statistics for IRF distinct part units of short-term acute care hospitals for areas identified as potentially at risk for improper payments in IRFs. The data include the number of Medicare discharges for the numerator and denominator for each target area, proportion for each target area, average Medicare payment for a claim in each target area and the sum of total Medicare payments for each target area for all IRF distinct part units of short-term acute care hospitals in the nation. For more information on the areas identified as potentially at risk for improper payments, please see the IRF PEPPER User’s Guide.  

 

National Top 20 Rehabilitation Impairment Categories (RICs) for  All IRFs (41kbs PDF, updated 04-17-2014)
Listings of the top 20 RICs by volume of Medicare discharges for 1) all IRFs in the nation, 2) all free-standing IRFs in the nation, and 3) all IRF distinct part units of short term acute care hospitals in the nation. The data are aggregated at the national level and include the number of discharges, proportion of discharges for the RIC to total discharges and national average length of stay for each RIC. The data represent the most recent four quarters of discharges through Q4FY13 (October 1, 2012 – September 30, 2013).  

 

National Top 20 Case Mix Groups (CMGs) for All IRFs (58kbs PDF, updated 04-17-2014)
Listings of the top 20 CMGs by volume of Medicare discharges for 1) all IRFs in the nation, 2) all free-standing IRFs in the nation, and 3) all IRF distinct part units of short-term acute care hospitals in the nation. The data are aggregated at the national level and include the number of discharges, proportion of discharges for the CMG to total discharges and national average length of stay for each CMG. The data represent the most recent four quarters of discharges through Q4FY13 (October 1, 2012 – September 30, 2013).

 

IRF Target Percent Boundaries for Free-standing IRFs and IRF Distinct Part Units of Short-term Acute Care Hospitals (128kbs PDF, updated 04-17-2014)
Graphs displaying, for each of the areas identified as potentially at risk for improper Medicare payments, the target area percents that are at the 80th, 50th and 20th percentiles for free-standing IRFs and for IRF distinct part units of short-term acute care hospitals for the most recent four quarters ending Q4FY13 (October 1, 2012 – September 30, 2013). For more information on the areas identified as potentially at risk for improper payments, please see the IRF PEPPER User’s Guide.   

 

Hospices

Jurisdiction Target Area Analysis – Hospices (48kbs PDF, updated 04-17-2014)
Provides statistics for areas identified as at risk for improper Medicare payments in hospices for each of the four Hospice MAC jurisdictions. The data include the number of Medicare beneficiary episodes of service for the numerator and denominator for each target area, proportion for each target area, average length of stay for the numerator episodes of service and the average Medicare payment and the sum of total Medicare payments for the numerator episodes of service for each target area for all hospices in each Hospice MAC jurisdiction for fiscal years 2011, 2012 and 2013. For more information on the areas identified as at risk for improper payments, please see the Hospice PEPPER User’s Guide.

 

Jurisdiction Top10 Terminal Conditions (53kbs PDF, updated 04-17-2014)
A listing of the top 10 terminal conditions by total number of Medicare decedents for each of the four Hospice MAC jurisdictions. The data are aggregated at the jurisdiction level. The data include the number of decedents, proportion of decedents for the terminal condition to total decedents and the jurisdiction average length of stay for each terminal condition. The data represent fiscal year 2013 (October 1, 2012 – September 30, 2013). For more information on the terminal conditions, please see the Hospice PEPPER User’s Guide.

 

National Target Area Analysis – Hospices (31kbs PDF, updated 04-17-2014)
Provides national-level statistics for areas identified as at risk for improper Medicare payments in hospices. The data include the number of Medicare beneficiary episodes of service for the numerator and denominator for each target area, proportion for each target area, average length of stay for the numerator episodes of service and the average Medicare payment and the sum of total Medicare payments for the numerator episodes of service for each target area for all hospices in the nation for fiscal years 2011, 2012 and 2013. For more information on the areas identified as at risk for improper payments, please see the Hospice PEPPER User’s Guide.

 

National Top 10 Terminal Conditions (29kbs PDF, updated 04-17-2014)
A listing of the top 10 terminal conditions by total number of Medicare decedents for all hospices in the nation. The data are aggregated at the national level. The data include the number of decedents, proportion of decedents for the terminal condition to total decedents and the national average length of stay for each terminal condition. The data represent fiscal year 2013 (October 1, 2012 – September 30, 2013). For more information on the terminal conditions, please see the Hospice PEPPER User’s Guide.

 

Partial Hospitalization Programs

National Target Area Analysis – All PHPs (29kbs PDF, updated 04-17-2014)
The link above provides national-level statistics for areas identified as potentially at risk for improper payments in PHPs. The data include the numerator count and denominator count for each target area, proportion for each target area, numerator average length of stay and the average and sum of Medicare payments for each target area for all PHPs in the nation for fiscal years 2011, 2012 and 2013. For more information on the areas identified as potentially at risk for improper payments and specifics on how the average length of stay and average and sum of payments are calculated, please see the PHP PEPPER User’s Guide.

 

National Target Area Analysis – Community Mental Health Center PHPs (38kbs PDF, updated 04-17-2014)
The link above provides national-level statistics for PHPs administered by CMHCs for areas identified as potentially at risk for improper payments in PHPs. The data include the numerator count and denominator count for each target area, proportion for each target area, numerator average length of stay and the average and sum of Medicare payments for each target area for all PHPs administered by CMHCs in the nation for fiscal years 2011, 2012 and 2013. For more information on the areas identified as potentially at risk for improper payments and specifics on how the average length of stay and average and sum of payments are calculated, please see the PHP PEPPER User’s Guide.

 

National Target Area Analysis – Hospital PHPs (38kbs PDF, updated 04-17-2014)
The link above provides national-level statistics for PHPs administered by hospital outpatient departments (short-term acute care hospitals, inpatient psychiatric facilities, inpatient rehabilitation facilities, long-term acute care hospitals, children’s hospitals) for areas identified as potentially at risk for improper payments in PHPs. The data include the numerator count and denominator count for each target area, proportion for each target area, numerator average length of stay and the average and sum of Medicare payments for each target area for all PHPs administered by hospitals in the nation for fiscal years 2011, 2012 and 2013. For more information on the areas identified as potentially at risk for improper payments and specifics on how the average length of stay and average and sum of payments are calculated, please see the PHP PEPPER User’s Guide.

 

National Top 20 Diagnoses for All PHPs (37kbs PDF, updated 04-17-2014)
A listing of the top 20 diagnoses by volume of episodes of care for all PHPs in the nation. The data are aggregated at the national level and include the number of episodes of care, proportion of episodes of care for the diagnosis to total episodes of care and the national average length of stay for each diagnosis code. The data represent fiscal year 2013 (October 1, 2012 – September 30, 2013). For more information on the top 20 diagnoses report, please see the PHP PEPPER User’s Guide.

 

National Top 20 Diagnoses for Community Mental Health Center PHPs (37kbs PDF, updated 04-17-2014)
A listing of the top 20 diagnoses by volume of episodes of care for PHPs administered by CMHCs. The data are aggregated at the national level and include the number of episodes of care, proportion of episodes of care for the diagnosis to total episodes of care and the national average length of stay for each diagnosis code. The data represent fiscal year 2013 (October 1, 2012 – September 30, 2013). For more information on the top 20 diagnoses report, please see the PHP PEPPER User’s Guide.

 

National Top 20 Diagnoses for Hospital PHPs (37kbs PDF, updated 04-17-2014)
A listing of the top 20 diagnoses by volume of episodes of care for all PHPs administered by hospital outpatient departments (short-term acute care hospitals, inpatient psychiatric facilities, inpatient rehabilitation facilities, long-term acute care hospitals, children’s hospitals). The data are aggregated at the national level and include the number of episodes of care, proportion of episodes of care for the diagnosis to total episodes of care and the national average length of stay for each diagnosis code. The data represent fiscal year 2013 (October 1, 2012 – September 30, 2013). For more information on the top 20 diagnoses report, please see the PHP PEPPER User’s Guide.

 

PHP Target Percent Boundaries for CMHC PHPs and Hospital PHPs (101kbs PDF, updated 04-17-2014)
Graphs displaying, for each of the areas identified as potentially at risk for improper Medicare payments, the target area percents that are at the 80th, 50th and 20th percentiles for CMHC PHPs and for Hospital PHPs for fiscal year 2013 (October 1, 2012 – Septebmer 30, 2013). For more information on the areas identified as potentially at risk for improper payments, please see the PHP PEPPER User’s Guide.

 

Skilled Nursing Facilities

National Target Area Analysis (31kbs PDF, updated 04-23-2014)
Provides national-level statistics for areas identified as potentially at risk for improper Medicare payments in SNFs. The data include the numerator and denominator counts for each target area (number of RUG days, assessments or episodes of care) for Medicare episodes of care ending in each time period (fiscal years 2011, 2012 and 2013), the proportion for each target area, average length of stay for the numerator (not applicable for the “Change of Therapy Assessment” target area), and average and sum of Medicare payment for the “90+ Day Episodes of Care” target area for all SNFs in the nation. For more information on the areas identified as potentially at risk for improper payments, please see the SNF PEPPER User’s Guide.

 

National Top 20 Resource Utilization Groups (RUGs) (32kbs PDF, updated 04-23-2014)
A listing of the top 20 RUGs by Medicare days billed for all SNFs in the nation. The data are aggregated at the national level and include the number of Medicare RUG days billed, proportion of days billed to the RUG to total RUG days, the proportion of episodes of care with the RUG billed to total episodes of care, and the average length of stay for the RUG. The total number of SNF episodes of care in the nation is identified in the header in the fourth row. The data represent the episodes of care ending in the most recent four quarters through Q4FY13 (October 1, 2012 – September 30, 2013).

 

National Top 20 Resource Utilization Groups (RUGs) for 90+Day Episodes of Care (32kbs PDF, updated 04-23-2014)
For episodes of care with 90+ days, lists the top 20 RUGs by Medicare days billed for all SNFs in the nation. The data are aggregated at the national level and include the number of Medicare RUG days billed, proportion of days billed to the RUG to total RUG days, the proportion of 90+ day episodes of care with the RUG billed to total 90+ day episodes of care, and the average length of stay for the RUG. The total number of SNF episodes of care with 90+ days in the nation is identified in the header in the fourth row. The data represent the episodes of care with 90+ days ending in the most recent four quarters through Q4FY13 (October 1, 2012 – September 30, 2013).

 

SNF Target Percent Boundaries for Free-standing SNFs and Short-term Acute Care Hospital-based SNFs (77kbs PDF, updated 04-23-2014)
Graphs displaying, for each of the areas identified as potentially at risk for improper Medicare payments, the target area percents that are at the 80th, 50th and 20th percentiles for free-standing SNFs and for SNFs that are part of a short-term acute care hospital for the most recent four quarters ending Q4FY13 (October 1, 2012 – September 30, 2013). For more information on the areas identified as potentially at risk for improper payments, please see the SNF PEPPER User’s Guide.

 

State Target Area Analysis (396kbs Excel, 04-23-2014)
Provides state-level statistics for areas identified as potentially at risk for improper Medicare payments in SNFs. The data include the numerator and denominator counts for each target area (number of RUG days, assessments or episodes of care) for Medicare episodes of care ending in each time period (fiscal years 2011, 2012 and 2013), the proportion for each target area, average length of stay for the numerator (not applicable for the “Change of Therapy Assessment” target area), and average and sum of Medicare payment for the “90+ Day Episodes of Care” target area for all SNFs in each state with three or more SNFs. The file is a Microsoft Excel workbook; click on the worksheet tabs to obtain the report for each state. There are graphs in the workbook that compare the target area percents for all states and the nation for each target area. Target area statistics are reported when there are at least three SNFs with a numerator count of at least 11. For more information on the areas identified as potentially at risk for improper payments, please see the SNF PEPPER User’s Guide.

 

State Top 20 Resource Utilization Groups (RUGs) (342kbs Excel, 04-23-2014)
A listing of the top RUGs (up to 20) by Medicare days billed for all SNFs in each state with three or more SNFs. The data are aggregated at the state level and include the number of Medicare RUG days billed, proportion of days billed to the RUG to total RUG days, the proportion of episodes of care with the RUG billed to total episodes of care, and the average length of stay for the RUG. The total number of SNF episodes of care in the state is identified in the header in the fourth row. The data represent the episodes of care ending in the most recent four quarters through Q4FY13 (October 1, 2012 – September 30, 2013). This file is a Microsoft Excel workbook; click on the worksheet tabs to obtain the report for each state.

 

State Top 20 Resource Utilization Groups (RUGs) for 90+Day Episodes of Care (336kbs Excel, 04-23-2014)
For episodes of care with 90+ days, lists the top 20 RUGs by Medicare days billed for all SNFs in each state with three or more SNFs. The data are aggregated at the state level and include the number of Medicare RUG days billed, proportion of days billed to the RUG to total RUG days, the proportion of 90+ day episodes of care with the RUG billed to total 90+ day episodes of care, and the average length of stay for the RUG. The total number of SNF episodes of care with 90+ days in the state is identified in the header in the fourth row. The data represent the episodes of care with 90+ days ending in the most recent four quarters through Q4FY13 (October 1, 2012 – September 30, 2013). This file is a Microsoft Excel workbook; click on the worksheet tabs to obtain the report for each state.